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CMS Cuts Stage 2 MU Patient Engagement Threshold to One User

By Jennifer Bresnick

- The dreaded five percent patient engagement requirement for Stage 2 meaningful use is no more, now that CMS has released its final flexibility rule covering changes to the EHR Incentive Programs between 2015 and 2017.  Despite broad adoption of patient portal technology, the five percent threshold has been a major challenge for healthcare providers attempting to meet Stage 2 objectives.

Patient engagement in Stage 2 meaningful use

CMS first proposed the downshift in April, responding to widespread consternation among both eligible providers and eligible hospitals unable to strong-arm five percent of their patients into viewing, downloading, or transmitting their data. 

Immature technology and a disappointing user experience, coupled with poor education about portal availability and the fact that many patient populations are unwilling or unable to access their health data online, has left providers coming up frustratingly short on their numbers.

“One of the witnesses [at a recent Senate hearing], who owns a small family practice in Nebraska, said he only had two hours to go before the reporting deadline, and they were two patients short of meeting their secure messaging threshold,” Robert Tennant, Senior Policy Advisor at the Medical Group Management Association (MGMA), told earlier this year.  “So he had to call up these two patients and essentially beg them to send a message, even if it was something irrelevant like the scores to a basketball game.”

“You take a step back and it’s kind of funny, but also it’s disconcerting that the whole point of this program, which is to provide better quality care to patients, isn’t helping us find that,” he added.  “We’re finding that physicians are checking boxes, trying to meet the requirements to avoid getting penalized, and that is simply wrong.”

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In the flexibility rule released yesterday evening, CMS made it a point to say that they are trying to shift the EHR Incentive Programs away from the check-box mentality and towards a sense that meaningful use is a tool to accomplish more meaningful patient care improvements.  Slashing the five percent patient engagement threshold – and presumably taking some time in the future to reexamine the proposed 25 percent threshold for Stage 3 in 2017 and beyond – is a major step towards realizing this goal.

The rule states the following in relation to the patient engagement requirement:

There are two objectives for EPs and one objective for eligible hospitals and CAHs that specifically contain measures requiring a provider to track patient action. We proposed to modify these measures as follows:

Patient Action to View, Download, or Transmit (VDT) Health Information

Remove the 5 percent threshold for Measure 2 from the EP Stage 2 Patient Electronic Access (VDT) objective. Instead require that at least 1 patient seen by the provider during the EHR reporting period views, downloads, or transmits his or her health information to a third party.

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Remove the 5 percent threshold for Measure 2 from the eligible hospital and CAH Stage 2 Patient Electronic Access (VDT) objective. Instead require that at least 1 patient discharged from the hospital during the EHR reporting period views, downloads, or transmits his or her health information to a third party.

Secure Electronic Messaging Using CEHRT

Convert the measure for the Stage 2 EP Secure Electronic Messaging objective from the 5 percent threshold to a yes/no attestation to the statement: "The capability for patients to send and receive a secure electronic message was enabled during the EHR reporting period".

Providers that stand to benefit from these changes include those practicing in low-income areas with spotty home broadband access for patients, those serving elderly populations with limited computer proficiency, and specialists who have trouble sustaining engagement when treating patients on a more episodic basis than is typical in primary care.

A December 2014 survey found that sixty four percent of patients are not portal users.  More than a third of those patients were not even aware that their providers gave them the option of viewing or downloading their information online, which Tamara St. Claire, Chief Innovation Officer of Commercial Healthcare for Xerox, attributed to a failure of communication between physicians and their patients.

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“Physicians just aren’t having that dialogue,” St. Claire said to  “When we look at some of the best practices out there, we see that having that conversation multiple times along the patient’s path through the office is most effective.  And we think having that conversation directly with their physician is going to be most important.  People really want to hear it from their physician, because they’re that trusted source.  Even as medicine is changing, having that talk with the physician is probably going to have the most impact.”

Dropping the threshold may relieve the immediate pressure on providers to ensure that their patients are receiving the right education, but providers should keep in mind that CMS has not yet modified or delayed the 25 percent benchmark proposed for Stage 3.  That means that healthcare organizations may still have to ramp up their efforts to secure an adequate number of email addresses and log-ins before 2017 or 2018 rolls around.


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